Individual
SUAH PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8725 S TACOMA WAY, LAKEWOOD, WA 98499-4544
(253) 535-5552
Mailing address
5207 88TH STREET CT SW APT E207, LAKEWOOD, WA 98499-3176
(949) 304-8785
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
0001286995
VA
363LF0000X
Family Nurse Practitioner
0024179524
VA
363LF0000X
Family Nurse Practitioner
Primary
AP61084806
WA
Other
Enumeration date
06/18/2020
Last updated
01/18/2021
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